Pulse System: Pulsed Magnetic Cellular Exerciser Informed Consent for Session or Sessions
I ____________________________,(the typed name you submit for electronic submission will serve as the fill in the blank for this form) hereby request a Pulsed Magnetic Cellular Exercise session. I understand that the Pulse System creates a fully adjustable pulsed magnetic field. I understand that the information shared by the demonstrator are his/her personal opinions and are intended for educational purposes only.
Product Disclaimer The Pulse System produces magnetic field energy, which passes freely through tissue for the purpose of cellular exercise to promote and support a sense of wellbeing. The FDA has not evaluated the Pulse System. It is not intended for the diagnosis, treatment or cure of any medical condition. The Pulse System is not a medical device and we cannot make any claims that we can affect medical conditions. We understand this general statement regarding pulsing magnetic fields to be accurate:
“PEMF (pulsed electromagnetic field) devices do not treat a specific condition. Instead they optimize the body’s natural self-healing and self-regulating function" --Dr. Magda Havas Associate Professor of Environmental & Resource Studies at Trent University
Do not use if:
Before beginning a PEMF Exercise Session remove the following from your person:
Electronic or battery operated devices, keys, wallets, cards with magnetic strips such as credit cards and hotel keys, jewelry and hearing aids. cellphones, laptops, etc.
If you are unsure whether pulsed magnetic cellular exercise is right for you, consult with your licensed health care provider(s)
During a PEMF Exercise Session if you experience natural reactions that include but are not limited to nausea, headache, fatigue or any uncomfortable sensations we recommend you suspend the session and consult your doctor
Beyond what is stated above, I_________________________, (name submitted electronically) understand that other risks associated with a pulsed magnetic exercise session are unforeseeable and that the demonstrator, the manufacturer, the marketer, employees, agents and affiliates cannot accept any liability for loss or damages incurred as the result of the Pulse System session. I release now and forevermore all liability from Angela A Dockter, or Angela A Dockter, LLC, or any host, organizer/homeowner/renter, or landlord of any office of any PEMF sessions I attend anywhere for any reason at anytime. I freely choose to participate in PEMF session or sessions and feel adquately informed to do so and I accept all liablity for my health and wellness choices using PEMF. I further understand Angela is a Traditional Naturopath and Quantum Energy Practitioner and NOT a licensed medical provider and she does not diagnose nor prescribe medications or supplements and her advice is not to be replaced with the advice of a licensed medical practitioner. Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Angela A Dockter and Angela A Dockter, LLC from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).
I reserve the right to use the knowledge I have gained in the care of my own body in any legal manner I may choose. I have read this form and voluntarily agree to the Pulse System session on my person assuming all liability for any and all results or consequences. My electronic signature in the form below will stand as legal and binding on the date of submission.
I ____________________________,(the typed name you submit for electronic submission will serve as the fill in the blank for this form) hereby request a Pulsed Magnetic Cellular Exercise session. I understand that the Pulse System creates a fully adjustable pulsed magnetic field. I understand that the information shared by the demonstrator are his/her personal opinions and are intended for educational purposes only.
Product Disclaimer The Pulse System produces magnetic field energy, which passes freely through tissue for the purpose of cellular exercise to promote and support a sense of wellbeing. The FDA has not evaluated the Pulse System. It is not intended for the diagnosis, treatment or cure of any medical condition. The Pulse System is not a medical device and we cannot make any claims that we can affect medical conditions. We understand this general statement regarding pulsing magnetic fields to be accurate:
“PEMF (pulsed electromagnetic field) devices do not treat a specific condition. Instead they optimize the body’s natural self-healing and self-regulating function" --Dr. Magda Havas Associate Professor of Environmental & Resource Studies at Trent University
Do not use if:
- you have an implanted electronic device including: pacemaker, defibrillator, cochlear hearing device, spinal stimulator, etc.
- you are pregnant or could be
- you are actively bleeding, hemorrhaging, or during heavy menstruation.
- if you have a history of seizures or blood clots please bring a doctors note prior to doing a sessions
- you have ever had an organ transplant
Before beginning a PEMF Exercise Session remove the following from your person:
Electronic or battery operated devices, keys, wallets, cards with magnetic strips such as credit cards and hotel keys, jewelry and hearing aids. cellphones, laptops, etc.
If you are unsure whether pulsed magnetic cellular exercise is right for you, consult with your licensed health care provider(s)
During a PEMF Exercise Session if you experience natural reactions that include but are not limited to nausea, headache, fatigue or any uncomfortable sensations we recommend you suspend the session and consult your doctor
Beyond what is stated above, I_________________________, (name submitted electronically) understand that other risks associated with a pulsed magnetic exercise session are unforeseeable and that the demonstrator, the manufacturer, the marketer, employees, agents and affiliates cannot accept any liability for loss or damages incurred as the result of the Pulse System session. I release now and forevermore all liability from Angela A Dockter, or Angela A Dockter, LLC, or any host, organizer/homeowner/renter, or landlord of any office of any PEMF sessions I attend anywhere for any reason at anytime. I freely choose to participate in PEMF session or sessions and feel adquately informed to do so and I accept all liablity for my health and wellness choices using PEMF. I further understand Angela is a Traditional Naturopath and Quantum Energy Practitioner and NOT a licensed medical provider and she does not diagnose nor prescribe medications or supplements and her advice is not to be replaced with the advice of a licensed medical practitioner. Except in the case of gross negligence or malpractice, I or my representative(s) agree to fully release and hold harmless Angela A Dockter and Angela A Dockter, LLC from and against any and all claims or liability of whatsoever kind or nature arising out of or in connection with my session(s).
I reserve the right to use the knowledge I have gained in the care of my own body in any legal manner I may choose. I have read this form and voluntarily agree to the Pulse System session on my person assuming all liability for any and all results or consequences. My electronic signature in the form below will stand as legal and binding on the date of submission.